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Are the View of Helicobacter Pylori Colonized in the Oral Cavity an Illusion?

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Are the View of Helicobacter Pylori Colonized in the Oral Cavity an Illusion? OPEN Experimental & Molecular Medicine (2017) 49, e397; doi:10.1038/emm.2017.225 Official journal of the Korean Society for Biochemistry and Molecular Biology www.nature.com/emm REVIEW Are the view of Helicobacter pylori colonized in the oral cavity an illusion? JKC Yee Urea breath test (UBT), as a leading preferred non-invasive diagnostic technology, but may not be able to detect oral H. pylori. With negative results of UBT, the patient may have an oral infection. On the basis of the fact of success, eradication rate may increase by 21% in the 95% Cl range after the elimination of oral H. pylori, the author believes oral H. pylori does exist and the oral cavity is the second colonized site aside its primary site of the stomach. H. pylori migrated out of Africa along with its human host circa 60 000 years ago; they are not lives in stomach only. In this review article, evidence established in recent years studies with use more appropriate technology had been listed and discussed. The author considers the oral cavity is a black hole for H. pylori infection that significant effective on gastroenterology and another medical field. The role of the oral cavity as the source of H. pylori infection is so controvert in past years. It seems like a human being having a second-time face to discover H. pylori in the history. Experimental & Molecular Medicine (2017) 49, e397; doi:10.1038/emm.2017.225; published online 24 November 2017 INTRODUCTION because the majority of physicians and scientists in this field do Most scientists in this field proposed there are no living not consider oral H. pylori are living bacteria. I estimate ~ 20% H. pylori lives in the mouth and positive response of the oral of the population of Asia having H. pylori of oral cavity.4 There cavity by PCR due to reflux from the stomach. The survive of are ~ 280 million people of China having oral H. pylori H. pylori in the oral cavity lives for only a few hours. If this infection. There are 280 million people have the problem of proposal is right, then the dead bacteria should not have any recurrences of stomach H. pylori infection. The abuse and negative effective on eradication of stomach H. pylori infec- overuse of antibiotics occur everywhere.1,3,4 As today, antibiotic tions. However, there are a number of reports that indicated pollution that appears in food, water, even in children’surine eliminated oral H. pylori may help more patients recover from that become a serious concern.5 If we do not stop this abuse, stomach infection.1,2 These reports concluded that there is a antibiotic may kill 80 000 per year and cost 11.7 billion dollars significant relationship between stomach and oral H. pylori as medical expenses in China. This review will provide facts infection. This finding greatly explains why the annual H. pylori that indicating oral H. pylori infection exist and discuss how to recurrence rates were so high with the first year being 13.2% eliminating them without antibiotic. followed by the second-year and the third-year both being 18.4%, due to oral cavity infection.3 In developed countries, the THE CLOSE RELATIONSHIP BETWEEN PERIODONTAL H. pylori recurrence rates after successful eradication were very HEALTH AND H. PYLORI INFECTION low—which means that discrepancy exists and is likely Dye BA et al.6 report that a clinical periodontal study on 4504 determined by economic status. However, it still continues to participants during 10 years period that show the close relation be a considerable controversy on the fundamental issue of oral between the depths of advanced pockets and a positive blood H. pylori. For example, how the stomach infection occurs? test for H. pylori antibodies. They concluded that poor H. pylori stay in the mouth, then via the oral cavity come down periodontal health having periodontal pockets 45 mm always to stomach? What is the premium function of the oral cavity in associated with H. pylori infection of adults in US population.6 this process? Or the mouth is a second colonization site of Fernández-Tilapa G et al.7 use blood H. pylori antibody tests H. pylori? Hence, if the mode of H. pylori transmission remains found that the prevalence of H. pylori in oral cavity was higher unknown, we are unable to interrupt the spread of infection. (18.5%) among seropositive subjects compared with seronega- The resolution on these disputable issues is so important tive persons in México. However, they concluded there were no Research Lab of Oral H pylori, Everett, WA, USA Correspondence: Dr JKC Yee, Research Lab of Oral H pylori, 125 130th Street SE, Everett, WA 98208, USA. E-mail: [email protected] Received 14 December 2016; revised 20 March 2017; accepted 23 March 2017 Oral H. pylori JKC Yee 2 association between the presence of H. pylori and oral hygiene are not an important reservoir for H pylori and are probably habits. Furthermore, Nisha KJ et al.8 reported that H. pylori not a significant factor in transmission of the organism.19 may colonize in dental plaque that shows a strong relation with Author did not agree with their conclusion because the method periodontal diseases. Tsami A et al.9 also detected H. pylori of cell cultures used for high concentration of H. pylori in presenting in the subgingival dental plaque of children as well stomach not for oral cavity where the concentration of as their family. H. pylori at very low level. Author will discussion why failure Several reports have indicated that H. pylori colonies could of cell cultures occur in later section. be grown only from root canals but not from plaque. The root However, there are a number of published articles that canals of endodontic-infected teeth could be a reservoir for indicate there were no correlations between H. pylori gastritis living H. pylori that could serve as a potential source of and dental hygiene or periodontal disease. They concluded that transmission.10,11 either dental plaque or dentures have nothing to do with Recent studies have shown that they consistently found stomach H. pylori infection. At least, they consider oral H. pylori live in the oral cavity that strong like with recurrence H. pylori is not a significant factor cost stomach infection of stomach H. pylori infection. Furthermore, in a review article, and they areorganisms in transmission in the mouth. However, they indicted the treatment of periodontal disease may help the the key fact is that they did indeed detect H. pylori in the oral improvement of the symptoms of H. pylori-positive dyspeptic cavity, but with a different view of conclusion.20,21 They think patients.2 A large size of a clinical study of China shown a high the results of such studies should be considered prudently percentage of adults suffers from oral H. pylori infection, which because the oral cavity is the residence of several urease- also strong like with oral diseases; such as periodontal diseases producing species, including Streptococcus spp., Haemophilus and caries.12 spp. and Actinomyces spp. Those organisms also have high A review and Meta-analysis included 48 articles and 12 urease activity in dental plaque which is nothing to do with oral clinical trials, as well as a meta-analysis designed in 2011 that H. pylori.WhilethediagnosisofH. pylori in gastric samples you indicated a strong association between H. pylori infection of may see the microscopic appearance such as Gram-negative, mouth and H. pylori stomach infection. They found H. pylori curved or spiral-shaped rods which may not as H. pylori.Ifyou are the etiologic agent of periodontal disease. They concluded use microscopic appearance as a standard to check oral samples that there is a strong relation between mouth and stomach H. you can found many species have spirochetes appearance, pylori infection.13 Recent several meta-analyses report a similar including Treponema spp. so this standard has low specificity. conclusion regarding oral cavity and stomach.14–17 The total We should be prudent to make any conclusion.22 participants involved in the above meta-analyses are more than Namiot et al.23 conducted a clinical study. They reported in 20 000 individuals (Table 1). 65.6% of an adult having H. pylori antigens exist in dental Furthermore, combining full-mouth disinfection plus triple plaque. They concluded the occurrence of H. pylori antigens of therapy on periodontitis patients for oral H. Pylori infection dental plaque of natural teeth is not link with oral health status. increasing eradication success rate of stomach H. pylori After remove dental plaque of natural teeth and removable infection.18 dentures, the H. pylori still stay in mouth. However, Silva Although meta-analysis provided a right direction of period- et al.24 reported H. pylori was existing in the supragingival ontal diseases and H. pylori infection, however we should also plaque, but not in the subgingival plaque in the case if the discussion each individual study further since they reported a patient has periodontal disease and upper gastric diseases. They correlation in result but with negative conclusion, For example, concluded H. pylori may colonize in the supragingival site and A clinical study shows H pylori was detected in specimens of 34 it is strong like with oral hygiene. Chaudhry et al.25 suggested patients (54%). Because all of the cultures of dental plaque use two genes of the bacterium simultaneously amplified as were negative. They concluded that dental plaque or dentures compared to one gene amplification only then we have better Table 1 Meta-analysis of periodontal disease and oral H.
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